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Publisher
Springer, Berlin, Heidelberg
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Authors: Lidia Alcalá Teodoro Martín Antonio Luna
Publish Date: 2012
Volume: , Issue: , Pages: 255-278
Abstract
One of the most common clinical applications of DWI in the rectum is rectal cancer detection DWI has shown to increase the detection of rectal cancer in combination with T2weighted images as compared to the use only of T2weighted images being especially useful for the detection of small polyps ADC calculation allows reducing the number of false positives as rectal cancer usually shows low ADC values Furthermore DWI is also useful for delineating the cancer extension in the initial staging of rectal carcinomas since differentiation of cancer fibrous and inflammatory changes is possible DWI also allows the detection of a greater number of lymph nodes even those smaller than 3 mm compared to morphological MRI sequences Besides recent data anticipate a role for DWI in the differentiation between metastatic and benign lymph nodes in the primary staging of rectal carcinoma Perhaps the most revolutionary application that has emerged from DWI in rectal cancer evaluation is the ability to predict whether a patient with rectal cancer will respond to neoadjuvant chemotherapy and radiotherapy In a similar fashion DWI is a useful tool in the restaging of rectal cancer after neoadjuvant therapy and it may also distinguish between fibrosis and recurrent tumor DWI also is useful to further characterize masses other than rectal adenocarcinoma such as enteric cyst or retrorectal cystic hamartomas that will show higher ADC values than malignant ones Another application of DWI is to identify areas of activity in patients with inflammatory bowel disease and to distinguish acute and chronic areas of inflammation Even more in the rectosigmoid colon DWI has demonstrated its capability to accurately differentiate between inflammatory bowel disease and neoplastic involvement DWI in combination with T2weighted sequence has recently shown to be superior in the detection of anal fistula compared to only T2weighted sequence and to perform similarly to postcontrast sequences and T2weighted sequences together DWI may also differentiate between inactive fibrous fistula and active inflammatory ones
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